The institute of Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health, USA initiated the Research Grant Programme on tobacco control policy issues in Bangladesh in 2013. The aim of the programme is to encourage in-country scientists to conduct research and create a local evidence base for tobacco control policy in the country. This type of programme on tobacco control is the first of its kind and to-date, 50 studies have been conducted by researchers and managed by the Bangladesh Centre for Communication Programs (BCCP).
Some of the research findings in brief  presented here under:
Level of compliance with the Tobacco Control Act 2005 in relation to exhibition of vigilance notice at public places in Bangladesh
Dr. Shamim Jubayer - is working with the National Heart Foundation of Bangladesh as a Research Fellow.
The prevalence of smoking is high in Bangladesh and the Government is committed to curb use of tobacco in the country. According to the Tobacco Control Act 2005, a prescribed vigilance notice have to be displayed in public places. A well-designed compliance study can help assess the effectiveness of comprehensive laws and highlight the potential need for improved implementation and enforcement of the law.
Among the facilities visited, just over one-quarter had “No Smoking” signage displayed in visible places and less than one-quarter of signage complied with the Law in relation to size and color. Of the facilities, one-fifth that is 18.5% had “No Smoking” signage at the point of entry or exit. A majority of respondents (94.4%) knew about the existence of the Tobacco Control Act 2005 including 62.7% about the signage. In general, 86.0% of the respondents knew that smoking was banned at public places but only three-quarters knew that violation of the law would result in monetary fine as punishment.
This study identified that compliance with the law in relation to the display of “No Smoking” signage in public places is low. This is one of the potential areas of violations that need attention from enforcement agencies and policymakers.  
The role of mass media in tobacco control
Tahsina Sadeque - is a Television Journalist
The strength of evidence for mass media campaigns within the context of a comprehensive tobacco-control program continues to grow mass media provide effective tools for convincing tobacco users not to use tobacco, because they can communicate prevention messages directly to people. Mass media campaigns can directly influence an individual’s decision about quitting; smokers view or hear campaign messages, gain new insights and reflect on the implications on their own behavior. Bangladeshi media has been playing an active role in tobacco control and literature shows that the quality of tobacco control coverage in media is gradually improving.
Mass media was found to play a strong role in support of the amended Tobacco Control Law; its implementation; creation of public support against tobacco farming, exposing tobacco companies’ tactics and other tobacco control activities including passing of Tobacco Control Rules. In controlling tobacco supply and demand effectively, media has been assisting the government and anti-tobacco activists productively. Key informants opined spontaneously on tobacco control program publicity, interference of tobacco organization on media people, activities and influence of anti-tobacco organization on media, awareness building activities, Tobacco Control Law 2005 and Amendment 2013. Overall, the study shows evidence that mass media coverage of tobacco control issues is influencing the context of comprehensive tobacco control programs. To reduce tobacco consumption, along with strict enforcement efforts, media should be used to assist with the implementation of the Tobacco Control Law. A sustained nationwide campaign to educate the masses against the dangers of smoking and smokeless tobacco is needed and media can play an important role in creating awareness about the dangers associated with tobacco consumption.
Smokeless tobacco consumption and diabetic foot ulcer
Dr. Sharmin Khanam - is a medical graduate and currently works at icddr,b as a Clinical Fellow
If diabetes is left untreated, it can cause many complications including Diabetic Foot Ulcer (DFU). DFU, as one of the complications of Diabetic Mellitus, may be related to smokeless tobacco consumption. Foot ulceration is preventable, and relatively simple interventions can reduce amputations by up to 80%. In Bangladesh, a large proportion of the population are tobacco users, and many of them are diabetic patients. This group of people are not fully aware about the tobacco-related complications from diabetes.
Among cases, a majority (70.0%) were male and their mean (±SD) age was 53.2 ± 9.8 years while among the controls, more than half (58.0%) were male and their mean (±SD) age was 54.8±10.7 years. More than one-third of the cases (39.0%) and about half of the controls (47.0%)  had education level up to HSC. A statistical significant association was found between diabetic foot ulcer and level of education (p<0.05). Most of the cases used tobacco (92.0%) while only one-fourth  of the controls (25.0%) used tobacco. The association between tobacco consumption and diabetic foot ulcer was statistically significant (p<0.001). The study found that smokeless tobacco consumption was significantly higher among the cases in comparison to the controls (p<0.001), and that both types of tobacco consumption (smokeless tobacco and smoking) were significantly associated with diabetic foot ulcer (p<0.001). The study found a statistically significant relationship between duration of smokeless tobacco consumption and diabetic foot ulcer (p<0.001). Most of the cases (87.0%) and about one-third of the controls (34.0%) were showing uncontrolled diabetes mellitus. The association between glycaemic status (uncontrolled) and diabetic foot ulcer was statistically significant (p<0.001).
This study found that smokeless tobacco consumption and duration of use increases the risk of foot ulcer among diabetic patients. Lower socioeconomic status and less education were also found to be risk factors for developing diabetic foot ulcer. The study recommends effective awareness building programs for diabetes patients to discourage smokeless tobacco consumption to prevent development of diabetic foot ulcer, which is not only a debilitating condition for the victims but great financial burden for themselves and their families.
Compliance with tobacco control law in public places: A survey in Dhaka city
Md. Shahriar Shafiq - is an Assignment Coordinator at the Institute of Child and Human Development (ICHD)
Tobacco related illnesses are a major problem in Bangladesh and pose considerable challenges to the country’s overall economic development. Evidence from different studies indicates that a strong tobacco control policy can help to reduce smoking rates. Bangladesh enacted a tobacco control law in 2005 with some of the provisions of the WHO Framework Convention on Tobacco Control (FCTC) Guidelines, and then introduced an amendment in 2013. Some recent studies, newspaper reports and observation by researchers in Bangladesh found violations of the tobacco control law in public places in the country.
The survey found that more than 85.0% of respondents from all categories know about the tobacco control law in public places. Among the respondents, a majority that is 71.7% visitors and more than half of the city dwellers did not see any smoke-free signage in public places. Over one-fifth of respondents observed smoking in public places during the study period. In case of smokers, most (96.0%) mentioned they have never been punished for smoking in public places, nor did they see other people being punished for violating the law. Moreover, the authoritative figures were not fined for negligence of their duty.
The study also found tobacco buying/selling activities in certain places including by/to minors, which is non-compliant with the law. Violation of the law took place mostly in different places of the cinema halls, public transportation, stations and shopping malls. Lack of punishment and inadequate monitoring were the main causes for violating the law.
Regular monitoring, proper punishment for violating the law along with training for authorities and increased awareness among the general public is necessary to ensure compliance with the current tobacco control law. In addition, future tobacco control policy should consider comprehensive smoke-free public places with no exemptions and provisions for violation.
Patterns of electronic-cigarette use and users’ beliefs about its harmful effects
Dr. Tithi Das - is working as a Lecturer at the Department of Public Health of the Atish Dipankar University of Science and Technology
E-cigarettes deliver nicotine-containing aerosol (vapor) to the user by heating a solution typically comprised of propylene glycol, nicotine and flavoring agents. It also contains carcinogens, including nitrosamines, toxic chemicals such as di-ethylene glycol and tobacco-specific components suspected of being harmful to humans.
The respondents were between 23 and 32 years of age; the mean age of the study respondents was 28 years. One-fourth of the respondents smoked e-cigarettes for longer than one year and most of them used it within half an hour of waking up. More than 80% of the respondents had completed their education up to higher secondary level and a very few have completed only primary education. Out of two hundred respondents, 84.5% of the respondents currently smoked conventional cigarette parallel to the electronic cigarette. More than half of the respondents usually smoked inside their homes assuming that it may be harmful for both children and pregnant women. Close to 50% of the respondents believed that e-cigarettes were safe for their health; and in comparison to conventional cigarettes, e–cigarettes were safer. On the other hand, 50% reported short term effects from using electronic cigarettes including throat irritation, heart burn and dizziness.
This study has demonstrated that users harbor misperceptions about the health risks, addictive properties, and ease of cessation associated with electronic cigarettes. Such misperceptions have the potential influence to initiate, thereby increasing the number of e-cigarette smokers in Bangladesh. Without correct information about e-cigarettes, users are unable to make informed decisions about their smoking behavior. Therefore, it is vitally important that long-term health and cessation effects of e-cigarettes are examined and communicated to the public.
Heavy metals (Cr, Cd and Pb) in chewing and other categories of tobacco consumed in Bangladesh and their effects on health
Md. Tawhid Hossain - is an MSc Student at the Department of Soil, Water and Environment, University of Dhaka
Heavy metals are of concerned because of their potential accumulation in bio-systems through diversified contamination in food, air, water, soil and other major and minor sources.
Heavy metals have been reported to be associated with the toxicity of tobacco products and tobacco smoke. A number of elements have been identified as contributors to this toxicity. Several heavy metals are found in tobacco smoke, which have long (10–12 years) half-lives in the human body. Cigarette smoking is a major exposure route for cadmium (and to a lesser extent lead) in the general population. Under the circumstances it is necessary to determine the levels of heavy metals present in tobacco products to better predict associated risks and provide data to monitor, regulate and control the contents of tobacco products.
Concentration of Lead in smoked and smokeless tobacco ranged from 0-1.167µg/g and 0-6.167µg/g respectively. Concentration of Cadmium in smoked and smokeless tobacco ranged from 0.33-0.655µg/g and 0-1.26 µg/g respectively. The overall concentration curve or prevalence of metals was dominated by Chromium for both smoked and smokeless products. The concentration of Chromium in smoked and smokeless tobacco ranged from 0.25-3 µg/g and 0.36-6.29 µg/g respectively. Risk from Lead in both smoked and smokeless tobacco was least while Chromium posed a much higher risk for both smoked and smokeless tobacco users.
Lead concentration had the lowest toxicological risk among the three metals (Lead, Cadmium and Chromium). Cadmium and Chromium presented greater risk which crossed the “acceptable limit”, i.e. the US Environmental Protection Agency’s (USEPA’s) benchmark limit of 10E-4 to 10E-6.
Cadmium and Chromium are two Group 1 carcinogens classified by International Agency for Research on Cancer and potentially dangerous for individuals who consumed them in high amounts. Overall toxicity of most of the tobacco products examined was higher than generally recognized “acceptable limits”.
Due to the demonstrated adverse health effects of tobacco use, from the perspective of environmental and agricultural policy, tobacco cultivation and processing in Bangladesh should be at a minimum and controlled.
Compiled by: Stethoscope desk